Provider Demographics
NPI:1295782209
Name:ELBERG, LARISA (MD)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:ELBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 NE 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3523
Mailing Address - Country:US
Mailing Address - Phone:305-803-3695
Mailing Address - Fax:
Practice Address - Street 1:3855 NE 168TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3523
Practice Address - Country:US
Practice Address - Phone:305-803-3695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME912382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274849500Medicaid
FLI33007Medicare UPIN
FL50321Medicare ID - Type Unspecified